From the Guidelines
For possible cellulitis in a 14-month-old, empiric oral antibiotic therapy is recommended with close follow-up, as suggested by the 2018 WSES/SIS-E consensus conference recommendations 1. The first-line treatment typically includes amoxicillin-clavulanate (40 mg/kg/day divided every 8-12 hours) or cephalexin (50 mg/kg/day divided every 6-8 hours) for 7-10 days. If MRSA is suspected or prevalent in your area, consider clindamycin (30-40 mg/kg/day divided every 8 hours) 1. Some key points to consider in management include:
- Hospitalization with IV antibiotics (cefazolin, clindamycin, or oxacillin) is necessary for severe cases with systemic symptoms, facial involvement, rapid progression, or if the child appears toxic.
- While treating, elevate the affected area, apply warm compresses, and ensure adequate pain control with acetaminophen or ibuprofen.
- Monitor the child closely for improvement within 48 hours; lack of response may indicate need for medication change or hospitalization. The choice of antibiotics is guided by the common causes of cellulitis in young children, which are typically Streptococcus pyogenes or Staphylococcus aureus, as noted in the practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America 1. Careful attention to hydration status and fever control is also important in this age group. It's worth noting that the recommended duration of antimicrobial therapy can be as short as 5 days if clinical improvement occurs, but treatment should be extended if the infection has not improved within this time period, as recommended by the 2014 update 1.
From the Research
Management of Cellulitis in a 14-Month-Old
To manage possible cellulitis in a 14-month-old, the following steps can be considered:
- Diagnosis of cellulitis and exclusion of complicated or other more serious infections can be challenging, and practitioners need to be skilled in the diagnosis and treatment of cellulitis, including recognition of the need for inpatient treatment 2.
- The goal is to use the antibiotic with the narrowest spectrum for the shortest duration necessary to provide clinical improvement 2.
- Amoxicillin combined with clavulanic acid can be used for the treatment of soft tissue infections, including cellulitis, in children 3.
- Parenteral antibiotics, such as ceftriaxone or clindamycin, can be used to treat moderate to severe cellulitis in a pediatric day treatment centre, and this approach can be a viable alternative to hospitalization 4.
- A short course (5 days) of antibiotic therapy can be as effective as a standard course (10 days) for uncomplicated cellulitis 5.
- Clindamycin can be used to treat osteomyelitis, septic arthritis, and cellulitis in children, and it provides an effective alternative treatment for children who are sensitive to penicillin 6.
Treatment Options
Some treatment options for cellulitis in children include:
- Amoxicillin combined with clavulanic acid 3
- Ceftriaxone or clindamycin in a pediatric day treatment centre 4
- Levofloxacin for 5 days 5
- Clindamycin for osteomyelitis, septic arthritis, and cellulitis 6
Important Considerations
It is essential to note that:
- Cellulitis can be caused by streptococci bacteria or Staphylococcus aureus, and the choice of antibiotic should be based on the suspected causative organism 2.
- The diagnosis and treatment of cellulitis can be challenging, and practitioners need to be skilled in the diagnosis and treatment of cellulitis, including recognition of the need for inpatient treatment 2.
- The goal is to use the antibiotic with the narrowest spectrum for the shortest duration necessary to provide clinical improvement 2.